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911 Maryland Ave E Saint Paul MN 55106-2647 | |
(651) 776-2719 | |
(651) 771-3978 |
Full Name | |
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Speciality | Family Medicine |
Location | 911 Maryland Ave E, Saint Paul, Minnesota |
Authorized Official Name and Position | Paul Berrisford (CEO) |
Authorized Official Contact | 6517721572 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2025 Sloan Pl Suite 35 Saint Paul MN 55117-2007 Ph: (651) 772-2077 | 911 Maryland Ave E Saint Paul MN 55106-2647 Ph: (651) 776-2719 |
NPI Number | 1104044692 |
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Provider Enumeration Date | 04/23/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1104044692 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 1417 (Minnesota) | Primary |
Premiere Mental Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 Sherman St Ste 290, Saint Paul, MN 55102 Phone: 763-913-8125 |